Physical exercises for hematology patients

SHARE VIA E-MAIL
DOWNLOAD
PRINT

Prepared by Dane Nemac

Why should I exercise?

EN_CLL_Physical_Exercises_Article_1a

Exercise, or better yet, physical exertion represents a stimulus for all major body systems, e.g. cardiovascular, muscular, immune, endocrine systems, etc. If the stimulus is regular, it initiates the need of your body systems to adapt which makes coping with the physical exertion easier in the long run. That means your body systems start working more efficiently.

These adaptations can also prevent disease. Hormones are exerted in a more coordinated fashion which can influence regulation of tumor cell growth. Myokines that are being secreted from your muscles when they are active also have the same impact. Exercise also increases your antioxidant capacity, immune function, DNA stability, etc.

Recent studies have shown that regular exercise has many positive effects on cancer survivors:

  • Improved quality of life.
  • Improved overall functioning.
  • It is associated with reduced mortality.
  • Less cancer-related fatigue.
  • Reduced dependence on others.
  • Increased muscle strength.
  • Improved immune function.
  • Improved cardiorespiratory system.
  • Reduced risk of cardiovascular disease.
  • Better body composition.
  • Reduced number and severity of side-effects.
  • Reduced hospitalisation duration.

Safety first

  • Exercise is safe both during and after most types of cancer treatments, including intensive treatments such as a bone marrow transplant.
  • Patients with multiple or uncontrolled comorbidities (especially those with cardiovascular diseases) need to consider modifications to their exercise program in consultation with their physician.
  • Patients undergoing Hematopoietic stem cell transplant should avoid overtraining as vigorous exercise can lead to unwanted exercise-induced immune suppression.
  • Do not exercise if you are experiencing extreme fatigue, anemia, or ataxia.
  • Patients with compromised immune function should avoid public gyms and public pools until their white blood cell counts return to safe levels. Patients who have completed a bone marrow transplant are usually advised to avoid such exposures for one year after the transplant.
  • Patients undergoing radiation should avoid chlorine exposure to irradiated skin (e.g., from swimming pools).
  • Patients with significant peripheral neuropathies or ataxia may have a reduced ability to use the affected limbs because of the weakness or loss of balance. It might be better to use a stationary bicycle than walking on a treadmill.
  • Multiple myeloma patients should be treated as if they have osteoporosis. They should avoid contact sports and high-impact exercises.

Getting started

Avoid inactivity; after surgery return to normal daily activities as quickly as possible. Continue normal daily activities and exercise as much as possible during and after nonsurgical treatments.

 
 Choose a type of physical activity that suits you best and which you are comfortable performing. There is a variety of activities you can choose from - walking, strength exercises, cycling, running, yard work, or gardening, swimming, hiking, etc. We recommend that you start with walking and strength exercises suitable for your fitness level (there are some examples below).  Physical activity should be demanding enough (increased heart rate and breathing). Patients are advised not to choose a workout which is too strenuous and would leave them extremely fatigued.  
Exercise should last at least 20-30 minutes. But you can also divide it into shorter intervals (5-10 minutes) and take rests in between. Try to be active on as many days as possible. It is recommended that you start with a moderate intensity exercise three times a week if you were completely inactive up till now and gradually progress in your exercise in both, frequency and intensity. Physical activity should be demanding enough (increased heart rate and breathing). Patients are advised not to choose a workout which is too strenuous and would leave them extremely fatigued. 

Which exercises and how much is enough?

EN_CLL_Physical_Exercises_Article_1b

We divided exercise into three types that are most beneficial for you: aerobic training, strength training, and stretching. We conclude each exercise type with various examples of exercise schedules enabling you to better understand how to combine different types of exercise.

Aerobic training

Below you have a scheme of fifteen progression levels for aerobic training. It’s not necessary to start at Level 1; choose a level which you can currently complete. Once again keep in mind that physical activity should be demanding enough (increased heart rate and breathing), but that patients are advised not to choose a workout that is too strenuous and would leave them extremely fatigued. 

More precisely, your heart rate during exercise should range between 60-75 % of your maximum. If you have chosen a level that is too demanding, go one level down, and vice versa. That is considered as your starting point.

 

It is recommended that this type of exercise is performed at least three times a week. Then every 2-3 weeks try stepping up a level. Don’t get discouraged if you can’t keep up with the progression scheme. It’s not unusual for patients to go down a level for a few days or weeks due to the impact of the treatment. Keep in mind that moderate activity is always better than complete inactivity. 

Level 1: walking 4 intervals of 5 minutes and resting 2 minutes in between

Level 2: walking 2 intervals of 10 minutes and resting 2 minutes in between

Level 3: walking 3 intervals of 10 minutes and resting 2 minutes in between

Level 4: walking 2 intervals of 15 minutes and one 2 minute rest in between

Level 5: walking continuously for 30 minutes

Level 6: walking 2 intervals of 20 minutes and a 2 minute rest in between

Level 7: walking continuously for 40-60 minutes

Level 8: briskly walking 3 intervals of 5 minutes and slowly walking 3 intervals of 5 minutes in between

Level 9: briskly walking 4 intervals of 5 minutes and slowly walking 4 intervals of 5 minutes in between

Level 10: briskly walking 4 intervals of 6 minutes and slowly walking 4 intervals of 4 minutes in between

Level 11: slowly running 3 intervals of 3 minutes and slowly walking 3 intervals of 7 minutes in between

Level 12: slowly running 4 intervals of 3 minutes and slowly walking 3 intervals of 6 minutes in between

Level 13: slowly running 3 intervals of 5 minutes and slowly walking 3 intervals of 5 minutes in between

Level 14: slowly running 4 intervals of 5 minutes and slowly walking 4 intervals of 3 in between

Level 15: running slowly continuously for 30-40 minutes

    Exercises for hematology patients: Warm up

    Chronic lymphocytic leukemia (CLL), Multiple Myeloma

    Exercises for hematology patients: Strength training, Squat

    Chronic lymphocytic leukemia (CLL), Multiple Myeloma

    Exercises for hematology patients: Strength training, Push-up

    Chronic lymphocytic leukemia (CLL), Multiple Myeloma

    Exercises for hematology patients: Strength training, Standing row

    Chronic lymphocytic leukemia (CLL), Multiple Myeloma

    Exercises for hematology patients: Strength training, Bridge

    Chronic lymphocytic leukemia (CLL), Multiple Myeloma

    Exercises for hematology patients: Strength training, Core stabilization

    Chronic lymphocytic leukemia (CLL), Multiple Myeloma

    Exercises for hematology patients: Strength training, Shoulder flexion

    Chronic lymphocytic leukemia (CLL), Multiple Myeloma

    Exercises for hematology patients: Stretching

    Chronic lymphocytic leukemia (CLL), Multiple Myeloma
  • References

    Kathryn H. Schmitz, Kerry S. Courneya, Charles Matthews, Wendy Demark-Wahnefried, Daniel A. Galva, Bernardine M. Pinto, Melinda L. Irwin idr. (2010). American College of Sports Medicine Roundtable on Exercise Guidelines for Cancer Survivors. MEDICINE & SCIENCE IN SPORTS & EXERCISE: American College of Sports Medicine. DOI: 10.1249/MSS.0b013e3181e0c112.

    Sandra C. Hayes, Rosalind R. Spence, Daniel A. Galvão in Robert U. Newton. (2009). Australian Association for Exercise and Sport Science position stand: Optimising cancer outcomes through exercise. Journal of Science and Medicine in Spor;  2009 (12), 428–434. DOI:10.1016/j.jsams.2009.03.002.

    Yuan Zhou, Jinjie Zhu, Zejuan Gu, Xiangguang Yin. (2016). Efficacy of Exercise Interventions in Patients with Acute Leukemia: A Meta-Analysis. PLOS One; 2016.

    Saskia Persoon, Marie José Kersten, Karen van der Weiden, Laurien M. Buffart, Frans Nollet, Johannes Brug idr. (2013). Effects of exercise in patients treated with stem cell transplantation for a hematologic malignancy: A systematic review and meta-analysis. Cancer Treatment Reviews; 2013 (39), 682-690. DOI: http://dx.doi.org/10.1016/j.ctrv.2013.01.001.

    Kerry S. Courneya in Christine M. Friedenreich. (2011).  Physical Activity and Cancer. Springer.

    Moshe Frenkel in Kenneth Sapire. (2017). Complementary and Integrative Medicine in Hematologic Malignancies: Questions and Challenges. Curr Oncol Rep, 2017 (19:79). DOI 10.1007/s11912-017-0635-0.

    Claudio L. Battaglini. (2011). Physical Activity and Hematological Cancer Survivorship. Physical Activity and Cancer, 275 Recent Results in Cancer Research 186, DOI: 10.1007/978-3-642-04231-7_12.

    M Mello, C Tanaka in FL Dulley. (2003). Effects of an exercise program on muscle performance in patients undergoing allogeneic bone marrow transplantation. Bone Marrow Transplantation (2003) 32, 723–728. DOI:10.1038/sj.bmt.1704227.

    KY Wolin, JR Ruiz, H Tuchman in A Lucia. (2010). Exercise in adult and pediatric hematological cancer survivors: an intervention review.  Leukemia, 2010; 24 (1113–1120). DOI:10.1038/leu.2010.54.

    Fernando Dimeo, Stefan Schwartz, Thomas Fietz, Tabata Wanjura, Dieter Böning and Eckhard Thiel. (2003). Effects of endurance training on the physical performance of patients with hematological malignancies during chemotherapy. Support Care Cancer, 2003; 11:623–628. DOI: 10.1007/s00520-003-0512-2.

    Jessica M. Scott, Saro Armenian, Sergio Giralt, Javid Moslehi, Thomas Wang and Lee W. Jones. (2016). Cardiovascular disease following hematopoietic stem cell transplantation: Pathogenesis, detection, and the cardioprotective role of aerobic training. Critical Reviews in Oncology/Hematology 98 (2016) 222–234.

    Chris P. Repka , Brent M. Peterson, Jessica M. Brown, Trent L. Lalonde, Carole M. Schneider and  Reid Hayward. Cancer Type Does Not Affect Exercise-Mediated Improvements in Cardiorespiratory Function and Fatigue. Integrative Cancer Therapies 2014, Vol. 13(6) 473–481. DOI: 10.1177/1534735414547108.

show more